Anp and amp conference 24th april 2013 a

Advanced Practice Where does it fit?

Contents • • • • • •

National Policy Context Health Care Reform Programme National Clinical Programmes National Office of Clinical Audit Productive Series Measuring Outcomes (KPI’s, Metrics)

Background/Health Policy Context • Future Health • Service Plan 2013 • HIQA National Standards for Safer and Better Health Care • A Vision for Mental Health Nursing • European Working Time Directive • Francis Report

Where are we starting from in 2013?

Grade AMP

Total Head Count 3

Total WTE 3

APN Children

4

4

ANP General

79

77

ANP I/D

1

1

ANP Psychiatry

9

9

Total

96

94

Future Health A Strategic Framework for Reform of Health Service 2012 – 2015 Department of Health November 2012

What the reforms will mean?

• • • • • • •

Improved health and wellbeing Faster, fairer access to hospital care Free access to GP care Better management of chronic illness More people cared for in their homes Improved quality and safety Affordability

Service Plan 2013 • Reflects Future Health’s full year implementation • Establishing new Directorate structure • Patient Safety Agency • €721m reduction in 2013 (€3.3bn since 2008 – 22%) • Target reduction of 2,400 WTE’s to reach 98,955

HIQA National Standards for Safer and Better Health Care 2012 Provide a roadmap for improving governance, quality and patient safety.

45 Standards

A significant challenge to implement

National Standards for Safer Better Healthcare Supporting Implementation

Continued • • • •

•

Five Key Points Apply to all HSE Funded Services (except Mental Health) Basis for future licensing Monitoring to commence late 2013 Acute and National Ambulance service first Not an option

Quality and Performance Information Tool • Designed to facilitate services assess against the National Standards • Facilitate a consistent approach to implementing the national standards • Finalised tool will be circulated shortly

• • • •

A Vision for Psychiatric/Mental Health Nursing Adopting a Recovery Approach ‘Belief that recovery is possible should underpin all our practice’ Metrics – To monitor progress and professional performance National practice standards for professionals Recommendation 10 – Advanced Practice roles

Francis Report – Mid Staffordshire Initial report uncovered appalling standards of care as follows: • Patients left in soiled bed linen • Families cleaned toilets for fear of infection • Calls to bathroom ignored • Food and drink left out of reach • Pain relief late or not provided • Patients unwashed

Francis Report continued • • • • • • •

Findings Culture of tolerance of poor standards No culture of listening to patients Poor Governance Lack of focus on standards Inadequate standard of nursing/midwifery Wrong priorities by Trust Loss of corporate memory

Francis on Nursing “It

is clear that the nursing issues found in Stafford are not confined to that hospital but are found throughout the country. This is not to deny that much high-quality, committed and compassionate nursing is carried out day in and day out, often with inadequate recognition. However, all in the profession must surely recognise that the challenges to the maintenance of proper standards and protection of patients have never been greater.

Until this scandalous decline in standards is reversed, it is likely that unacceptable levels of care will persist and therefore it is an area requiring the highest priority. There is no excuse for not tackling it successfully. Much of what needs to be done does not require additional financial resources, but changes in attitudes, culture, values and behaviors.�

Are there lessons to be learnt for nursing and midwifery in Ireland?

EWTD DoH submit annual plans regarding progress to ensure EWTD compliance ‘It would be desirable also to rebalance staffing arrangements so as to have more nurse practitioners and phlebotomists….’

DoH, January 2012.

Health Care Reform Programme • Health and Wellbeing • Service Reform • Structural Reform • Financial Reform

National Clinical Programmes (34) • • • • • • • • • • • • • • • • •

Acute Coronary Syndrome Acute Medicine Anaesthesia Asthma Audiology Blood Transfusion / Haemochromatosis Care of Older People COPD Critical Care Cystic Fibrosis Dermatology Diabetes Emergency Medicine Endoscopy Epilepsy Heart Failure Mental Health

• • • • • • • • • • • • • • • • •

Neurology Obstetrics & Gynaecology OPAT Ophthalmology Orthopaedics Paediatrics & Neonatology Palliative Care Pathology Primary Care Radiology Rare Diseases Rehabilitation Medicine Renal Retrieval and Transport Rheumatology / MSK Stroke Surgery

Service input  43 Clinical Leads  23 National Programme Managers  25 Local Programme Managers  4 Regional Co-ordinators  Clinical Advisory Groups, DONM Reference Group, Therapy Professionals Committee  Strong multidisciplinary approach  25 Programmes have Lead Clinical Nurses/Midwives from the services and nominated by Directors of Nursing and Midwifery (DONMs), on their working groups.  15 Programmes have other senior nurses and midwives on working groups.  Over thirty Allied Health Professionals involved with the programmes.  Over 30 Pharmacists involved

National Clinical Programmes – ANP/AMP Development • ANP Pathway Epilepsy – 20 • Model of Care Documents – Rheumatology, Surgery, Critical Care • Further potential – Neonatology, Obs/Gynae, Heart Failure, COPD, Diabetes.

• National Emergency Medicine Programme ANP Capacity Building Strategy

National Office of Clinical Audit • Collaborative agreement between QPSD and RCSI • Oversee the establishment of sustainable clinical audit programmes in agreed specialties • Irish Audit of Surgical Mortality • Irish National Orthopaedic Register • National ICU Audit

Productive Series • Releasing time to care programme • Involves front line staff in redesigning and streamlining the way staff deliver care.

• 35 wards • Initial outcomes – reduced falls, stock savings and reduced unplanned absences • Lean Healthcare Academy International Award

Measuring Outcomes Key Performance Indicators Effective approach to measuring specific elements of nursing and midwifery care considered integral to the overall patient experience

National Nursing and Midwifery KPIs • • • • • •

Patient Falls Pressure Ulcers Medication Management Patient Observations Pilot and testing in 2013 Establish feasibility of data collection processes

Metrics • HSE North West and Dublin North East • ‘Test your care’ software solution – Heart of England Trust • Measure process and quality

Publications • Publishing research, results of audits etc • Transforming nurses/midwives’ research into publications (NUIG and HSE) • HSELand

Thank You Patrick Glackin